Private Health Insurance (Complaints Levy) Rules 2022

Administered by Department of Health, Disability and Ageing

Legislation au F2022L01199 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

 

Issued by the Authority of the Minister for Health and Aged Care

 

Private Health Insurance (Complaints Levy) Act 1995

 

Private Health Insurance (Complaints Levy) Rules 2022

 

 

Section 8 of the Private Health Insurance (Complaints Levy) Act 1995 (the Act) provides that the Minister may make Private Health Insurance (Complaints Levy) Rules providing for matters required or permitted by the Act to be provided, or necessary or convenient to be provided, in order to carry out or give effect to the Act.

 

The Act imposes levies on private health insurers conducting health insurance business. The Act provides that the rate of the complaints levy must be based on the number of complying health insurance policies on issue on the census day and may be different for policies under which different numbers of people are insured. The Act also provides that the rate of the complaints levy must not exceed $0.50 a quarter in respect of complying health insurance policies under which only one person is insured and, otherwise, $1.00 a quarter.

 

The complaints levy is collected in accordance with the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015. The Private Health Insurance (Levy Administration) Rules 2015 specify that the complaints levy is payable on 31 December each year.

 

Purpose of the Rules

 

The Private Health Insurance (Complaints Levy) Rules 2022 (the Rules) repeal and replace the Private Health Insurance (Complaints Levy) Rules 2021 (the Previous Rules) to alter the rate of complaints levy payable. The Rules also specify the complaints levy days and the census day for the purposes of the Act.

 

The purpose of the complaints levy is to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO). The functions of PHIO are set out at section 20D of the Ombudsman Act 1976. Functions of PHIO include dealing with complaints, conducting investigations, publishing and reporting information, and making recommendations.

 

The rate of the complaints levy is based on the expected administrative costs of the PHIO for the financial year. A new numerator, equal to the PHIO budget for the current financial year, is inputted into the formulas for calculating the complaints levy rates in the Rules each year unless the PHIO budget is the same as the previous financial year.

 

Details of the Rules are set out in the Attachment.

 

The Rules commence on the day following their registration on the Federal Register of Legislation.

 

 

 

 

Consultation

 

Private health insurers are aware the complaints levy amount they are required to pay changes from year to year, according to changes in the number of policies that private health insurers hold and increases/decreases in the expected administrative costs of the PHIO. Consequently, no consultation occurred in relation to these changes.

 

This Instrument is a legislative instrument for the purposes of the Legislation Act 2003.

 

 

ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLAINTS LEVY) RULES 2022

 

  1. Name

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Complaints Levy) Rules 2022 (the Rules).

 

2.             Commencement

 

Rule 2 provides that the Rules commence on the day after they are registered on the Federal Register of Legislation.

 

3.             Authority

 

Rule 3 provides that the Rules are made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995.

 

4.             Definitions

 

Rule 4 provides definitions for the Rules.

 

5.             Schedules

 

Rule 5 provides that each instrument that is specified in a Schedule to the Rules is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the Rules has effect according to its terms. Schedule 1 specifies and repeals the Previous Rules.

 

6.             Census day

 

Rule 6 provides that the census day is the 30 June last occurring before the day on which the levy is payable. This is unchanged from the day specified in Rule 6 of the Previous Rules.

 

7.             Complaints levy day

 

Rule 7 specifies that the complaints levy day is 1 October each year. This is unchanged from the day specified in Rule 7 of the Previous Rules.

 

8.             Rate of levy for a single policy

 

Rule 8 provides that the rate of complaints levy for a single policy on issue from an insurer on the census day is calculated using the formula:

 

$ 2,906,000.00

total number of single policies + (2 × total number of joint policies)

 

 

Subrule 8(2) provides that if the rate of levy calculated for a single policy on issue from an insurer is more than $0.50, the rate for the policy is $0.50.

 

9.             Rate of levy for a joint policy

 

Rule 9 provides that the rate of complaints levy for a joint policy on issue from an insurer on the census day is calculated using the formula:

 

2 x

$ 2,906,000.00

total number of single policies + (2 × total number of joint policies)

 

Subrule 9(2) provides that if the rate of levy calculated for a joint policy on issue from an insurer is more than $1.00, the rate for the policy is $1.00.

 

Schedule 1—Repeals

 

Schedule 1 specifies and repeals the Previous Rules.

 


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

 

Private Health Insurance (Complaints Levy) Rules 2022

 

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

 

Overview of the Legislative Instrument

The Private Health Insurance (Complaints Levy) Rules 2022 (the Rules) specify the days on which the complaints levy is imposed, and the rate at which it is imposed, for the purposes of the Private Health Insurance (Complaints Levy) Act 1995 (the Act). The purpose of the complaints levy is to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO).

 

A new rate of levy has been incorporated into the Rules.

 

Human rights implications

The Rules do not directly engage any of the individual human rights covered by the Human Rights (Parliamentary Scrutiny) Act 2011 because the complaints levy is imposed on private health insurers who conduct health insurance business, not on individuals.

 

However, the Rules indirectly engage article 12(1) of the International Covenant on Economic Social and Cultural Rights by assisting with the progressive realisation of the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

 

The complaints levy funds the operations of the PHIO, which protects the interests of private health insurance consumers. The PHIO supports consumers in dealing with complaints they have about access to, or administration of, private health insurance policies. The continued collection of the complaints levy at an appropriate level to fund the PHIO is critical to ensure that consumers and health care providers have confidence in the administration of the private health insurance system, particularly through effective complaints management and consumer information services.

 

Conclusion

The Rules are compatible with human rights because it supports the right to health by ensuring the continued funding of the PHIO at appropriate levels.

 

Mark Butler
Minister for Health and Aged Care

 

Overview

The Private Health Insurance (Complaints Levy) Act 1995 was enacted to address the need for a sustainable funding mechanism to support the Private Health Insurance Ombudsman (PHIO) in managing complaints related to private health insurance. Authorised by the Australian Parliament, the Act ensures that PHIO can effectively perform its functions, which include dealing with complaints, conducting investigations, and publishing information to protect the interests of private health insurance consumers. The Act was designed to provide a stable source of revenue through a complaints levy imposed on private health insurers, which varies based on the number of policies held and the number of insured individuals. The levy is intended to cover the administrative costs associated with the oversight and resolution of complaints within the private health insurance sector. The Private Health Insurance (Complaints Levy) Rules 2022 were introduced to update the rate of the complaints levy, aligning it with the expected administrative costs of PHIO for the financial year. These rules were developed under the authority of the Minister for Health and Aged Care and aim to ensure that PHIO can continue to operate effectively, thereby supporting the right to health by maintaining confidence in the administration of the private health insurance system. The levy rates are calculated based on the number of single and joint policies held by insurers, with caps set at $0.50 per quarter for single policies and $1.00 per quarter for joint policies. The introduction of these rules reflects the ongoing need to adapt the levy rates to the changing landscape of private health insurance and the administrative requirements of PHIO.

Scope and Application

The Private Health Insurance (Complaints Levy) Act 1995 applies to private health insurers who conduct health insurance business in Australia, imposing a levy intended to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO). The Act mandates that the rate of this complaints levy be determined based on the number of complying health insurance policies in effect on the census day, with specified maximum rates of $0.50 per quarter for single policies and $1.00 per quarter for joint policies. The levy is collected in accordance with the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015, which specify that the complaints levy is due annually on 31 December. The Private Health Insurance (Complaints Levy) Rules 2022, which amend the previous rules, detail the new rates of levy and specify the complaints levy day as 1 October each year and the census day as 30 June preceding the levy payment date. The Rules are compatible with human rights as they support the right to health by ensuring the PHIO, which handles complaints and supports consumers in dealing with private health insurance issues, is appropriately funded. The application of the Act is national, covering all private health insurers operating within Australia.

Key Provisions

The Private Health Insurance (Complaints Levy) Rules 2022, made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995, specify the days on which the complaints levy is imposed and the rate at which it is imposed. Rule 6 states that the census day is the 30 June last occurring before the day on which the levy is payable, while Rule 7 specifies that the complaints levy day is 1 October each year. The levy rates are calculated using specific formulas, with a cap of $0.50 per quarter for single policies and $1.00 per quarter for joint policies, as outlined in Rules 8 and 9 respectively. The obligations under the Act and the Rules require private health insurers to calculate and pay the complaints levy annually based on the number of policies they hold and the specified rates. Insurers must submit the levy by 31 December each year as per the Private Health Insurance (Levy Administration) Rules 2015. These rules ensure that the administrative costs of the Private Health Insurance Ombudsman (PHIO) are funded appropriately, enabling PHIO to carry out its functions effectively. Breach of the obligations to calculate and pay the complaints levy correctly can lead to civil or administrative consequences. While the Rules do not explicitly detail penalties for non-compliance, failure to comply with the levy requirements could potentially result in enforcement actions by the relevant authorities. It is important for private health insurers to adhere to these rules to avoid any disruptions in the services provided by PHIO, which are essential for consumer protection in the private health insurance sector.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.